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Cardiorespiratory fitness and physical function in children with cancer from diagnosis throughout treatment
  1. Troels Thorsteinsson1,
  2. Hanne Baekgaard Larsen1,
  3. Kjeld Schmiegelow1,2,
  4. Lone Friis Thing3,
  5. Peter Krustrup4,5,
  6. Mogens Theisen Pedersen3,
  7. Karl Bang Christensen6,
  8. Pernille Rudebeck Mogensen1,7,
  9. Anne Sofie Helms1,
  10. Lars Bo Andersen8,9
  1. 1 Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  2. 2 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3 Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
  4. 4 Department of Sport and Health Sciences, University of Exeter, College of Life and Environmental Sciences, Exeter, UK
  5. 5 Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
  6. 6 Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  7. 7 Department of Diabetes and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  8. 8 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  9. 9 Department of Teacher Education and Sport, Western Norway University of Applied Sciences, Røyrgata, Norway
  1. Correspondence to Dr Lars Bo Andersen;{at}


Background Children with cancer experience severe reductions in physical fitness and functionality during and following intensive treatment. This may negatively impact their quality of life.

Purpose To describe the physical capacity and functionality of children with cancer during and after treatment as well as the feasibility of physical activity intervention in the Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer study.

Patients and methods The study included children diagnosed from January 2013 to April 2016 with paediatric cancer or Langerhans cell histiocytosis, all treated with chemotherapy. Seventy-five of 78 consecutively eligible children (96.2%) were included. Median age was 11 years (range 6‒18). The physical capacity and function were assessed based on testing of physical strength, balance and cardiorespiratory fitness. Children were tested at diagnosis, 3 and 6 months after diagnosis and 1 year after cessation of treatment. The feasibility evaluation was inspired by the criteria for reporting the development and evaluation of complex interventions in healthcare.

Results All children participated in the physical intervention programme with no dropouts. Strenuous physical exercise and physiological testing during paediatric cancer treatment was safe and feasible, with only five minor adverse events during the intervention. Cardiorespiratory fitness was significantly lower in children with cancer than norms for healthy age-matched children at diagnosis (difference 19.1 mL/kg/min, 95% CI 15.4 to 22.7; p <0.0001), during treatment 3 and 6 months from diagnosis (difference 21.0 mL/kg/min, 95% CI 17.4 to 24.6; p <0.0001 and difference 21.6 mL/kg/min, 95% CI 17.3 to 25.8; p <0.0001, respectively) and 1 year after cessation of treatment (difference 6.9 mL/kg/min, 95% CI 1.1 to 12.7; p <0.0072). Furthermore, children with cancer experienced a pronounced decline in physical function.

Conclusion This study shows that it is safe and feasible to perform strenuous physical exercise and testing during paediatric cancer treatment and that children with cancer have significantly lower physical capacity and functionality than healthy age-matched norms.

Trial registration number NCT01772862.

  • paediatric
  • feasibility
  • physiological tests
  • exercise intervention
  • VO2peak

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  • Acknowledgements The study was supported by grants from the Novo Nordisk Foundation, the Danish Cancer Society, the Tryg Foundation, the Danish Children’s Cancer Foundation, the Hede Nielsen Foundation, the Aase and Ejnar Danielsen Foundation, the Arvid Nielsen Foundation, the Toyota Foundation, the ML Jørgensen and Gunnar Hansen Foundation and the Lundbeck Foundation. The authors would like to thank all of the children and families who participated in this study.

  • Contributors TT drafted the first version of the manuscript and, together with LBA, was responsible for the physical activity intervention. TT and LFT were responsible for the social activity intervention and ASH was responsible for the educational intervention in the RESPECT study. KS was scientific director and HBL was the main project coordinator for the RESPECT project. PK, MTP and PRM, together with TT and LBA, helped to validate and analyse the results. KBC, together with TT, was responsible for the statistics. All the authors read and approved the final manuscript and completed the ICMJE uniform disclosure form.

  • Competing interests None declared.

  • Ethics approval Information on the subjects is protected under the Processing of Personal Data and Health Act. The Danish Data Protection Agency (file. 2007-58-0015/nr.30-0734) and the Regional Ethics Committee for the Capital Region (file. H 3-2012-105) approved the project, and the project complies with the Helsinki II Declaration. In addition, the study is registered at (NCT01772849 and NCT01772862). The written informed consent of the relevant parents, guardians and children (above 15 years) was obtained following the provision of oral and written information.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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